Surgical retractor



Nov. 9, 1954 Filed Sept. 9, 1950 H. R. GRIESHABER SURGICAL RETRACTOR ESheets-Sheet l INVENTOR.

N0V- 9, 1954 H; R. GRIESHABER 2,693,795

SURGICAL RETRACTOR Filed Sept. 9, 1950 2 Sheets-Sheet 2 INVENTOR.

adjusted positions along the frame United States Patent O SURGICALRETRACTOR Herman R. Grieshaber, Chicago, lll. Application September 9,1950, Serial No. 184,064 Claims. (Cl. 128-20) This invention relates tosurgical devices and more particularly to an instrument known as aretractor.

In abdominal surgery, for example, it is particularly important thatthere be good exposure of the patients abdominal region in order tofacilitate the work of the surgeon. To effect this desired exposure aself-retaining surgical retractor is normally employed which engages andholds apart the protective skin and flesh of the patient during thecourse of the operation.

Various types of retractors have heretofore been proposed which are ofsuch design as to be either awkward to manipulate, not readily alterableto accommodate various surgical conditions encountered, or comprise anexcessive number of small disconnectible parts, which are apt to becomeloosened or disconnected during the operation and thereby seriouslyimpede the work of the surgeon.

Thus it is one of the objects of this invention to provide a retractorwhich is of such design as to be easily handled and quickly adjusted bythe surgeon or his assistant.

It is a further object of this invention to provide a retractor having aplurality of attachments which may be readily employed, therebyincreasing the usefulness of the instrument.

It is a still further object of this invention to provide a retractorwhich has relatively few disconnectible parts thereby minimizing thedanger of these parts becoming disconnected or loosened during thecourse of the operation.

It is a still further object of this invention'to provide a retractorwhich enables the wound to be readily widened, when desired, in order tocompensate for muscular relaxation of the patient or for furtherexploration by the surgeon during the course of the operation.

It is a still further object of this invention to provide a retractorwhich prevents accidental collapse of the7 wound once it has been spreadapart by the instrument.

It is a still further object of this invention to provide a retractorwhich may be readily disassembled, when desired, for cleaning.

Further and additional objects will appear from the description,accompanying drawings and appended claims.

In accordance with one embodiment of this invention, a retractor isprovided comprising an elongated frame member, a laterally extendingspreader arm rigidly mounted on said frame member, and a secondlaterally extending spreader arm slidably mounted on said frame memberfor movement towards or away from said first mentioned arm. Detachablymounted on the correspond ing end of each element. and in cooperationwith the tomatically locking the second of the second spreader armtowards the rst mentioned spreader arm. Adjustably mounted on the framemember and intermediate the aforementioned spreader arms is a thirdlaterally ex; tending spreader arm which is adapted to movelongitudinally and laterally of the frame member. Detachably mounted onthe end of the third spreader arm, which end is adjacent the other arms,is likewise a iiesh engaging element.

For a more complete understanding of this invention reference should bemade to the drawings, wherein Fig. 1 is a perspective view of theretractor showing portion is shaped so one of the flesh engagingelements detached from one of the spreader arms;

Fig. 2 is a fragmentary sectional view of the third spreader arm takenalong line 2 2 of Fig. l;

Fig. 3 is a fragmentary sectional view of the carrier for the thirdspreader arm taken along line 3-3 of Fig. l;

Fig. 4 is similar to Fig. 3 but shows a modified form of carrier;

Fig. 5 is a fragmentary top plan view of the slidably mounted spreaderarm;

Fig. 6 is a fragmentary view of the slidably mounted spreader arm takenalong lines 6 6 of Fig. 5;

Fig. 7 is a 'fragmentary top plan view of the flesh engaging element forthe third spreader arm;

Fig. 8 is a fragmentary sectional view of the iiesh engaging element forthe third spreader arm taken along lines 8-8 of Fig. 7; and

Fig. 9 is a fragmentary bottom view of the esh engaging element shown inFig. 7.

Referring now to the drawings and more particularly to Fig. l, aretractor is shown for use in abdominal surgery and the like. Thevarious parts of the retractor to be hereinafter enumerated are made ofsturdy, durable, non-corrosive material such as stainless steel. Thebasic parts of the retractor are a frame 10, a laterally extendingspreader arm 11 rigidly mounted thereon, a second laterally extendingspreader arm 12 slidably mounted on the frame, `and a third laterallyextending spreader arm 13 adjustably mounted on the frame intermediatearms 11 and 12.

The frame 10, as seen more clearly in Fig. l, comprises a pair ofelongated rods 10a and 10b arranged in a parallel, spaced relationship.The rods serve as guides for spreader arms 12 and 13. A portion 14 ofthe periphery of rod 10a, adjacent rod 10b, is serrated. Theseseri-ations 14 cooperate with a locking mechanism 15 which is mounted onspreader arm 12 and will be described more fully hereinafter. Threadablymounted on the end of rod 10a is a stop 16, which prevents spreader arml12 becoming disengaged from the frame 10. The rods 10a and 10b are heldin their proper spaced relationship by arm 11 which is mounted bywelding or any other suitable means to the end of the rods.

Spreader arm 12, as heretofore mentioned, s slidably mounted on frame 10and is adapted to move toward or away from arm 11. One end of arm 12 isprovided with a pair of sleeves 17 and 18, which embrace rods 10a and10b, respectively; see Fig. 5. A slot 20 is formed in the portion 21 ofarm 12 which is intermediate rods 10a and 10b and in a portion of sleeve17. Disposed within slot 20 is the locking mechanism 15 hereinabovementioned. l

The mechanism comprises a spring-actuated pawl 22 having a pointed tip23 formed thereon which is adapted to automatically seat in any one ofthe serrations 14' formed on rods 10a. The pawl 22 is normally held inlocking engagement with rod 10a by means of a leaf spring 24. O ne endof the spring is secured to the pawll and the other end thereof engagesportion 21 of the arm' l2. The spring causes the pawl 22 to normallypivot counterclockwise about pin 25. A portion 26 of the pawl is exposedand may be depressed by the surgeon to effect unlocking of arm 12. Theserrations, as shown more clearly in Fig. 5, are shaped so as to preventmovement of arm 12 towards arm 11, except when pawl 22 is depressed.However, the serrations allow the arm 12 to move away from arm 11without depressing the pawl. Thus the surgeon may readily effectspreading apart of the wound by pushing outwardly at any point on arm12.

rThe construction of the remainder of arm 12 is similar to arm 11 andtherefore only arm 12 will be described in detail. Extending laterallyfrom frame 10 is the shank portion 27 of the arm. The shank portion 27is bent outwardly slightly so as to effect greater exposure of thewound. The free end 28 of the shank as to be substantially square incrosssection. Formed in the surface of end 28, which surface is awayfrom arm 11, is a groove 30 which cooperates with a iesh-engagingelement 31.

The flesh-engaging element 31 comprises a sleeve por'- a securing device33 mounted on the' sleeve;

and a blade portion 34 extending inwardly towards the other arm anddownwardly from -the-sleeve. The `sleeve portion 32 snugly embraces theshaped end 28 of the arm. Thus once the element 31 has been positionedon end 28 it cannot turn thereabout.

The securing device 33, as seen in Fig. 5, .comprises a-leaf spring 35,which is rivetedat point 36`to-the sleeve. Secured to the ,free yend-ofspring 35 ris a detent37 which has the nose portion 38 thereoflprojecting through an opening 40 formed in the sleeve. The Vtip .of"the nose portion V-is adapted to normally rest in a recess ,or groove30 thereby preventing the element from slipping -endwise `olf the annonce it has been properly positioned thereon. To remove the element fromthe iend 28, vthe detent is merely `pulled outwardly :by .the ,fingersof surgeon until it is `clear of the groove and then .the element isAslipped off :the end 28 of the arm. -It is to be noted that thesecuring device V33 is of unitary construction. This feature isimportant in that in prior instruments of this type, as above mentioned,the 'esh-engaging '.element was secured to the spreader arm by smalldetachable -securing devices, such as screws, which .frequently becamedetached during the course 4of vthe operation and occasionally foundtheir way into the patients f wound.

Various types and sizes of esh-engaging Ielements, two of which areshown in Fig. l, may be 'used ldepending upon the type of surgery to beperformed and the condition of the patient. vFor example, if theV,incision is deep, an element having a long blade lis employed. Wherethe patient has considerable fatty tissue surrounding the infected area,an element having va web-.like blade yis used of the type shown in Fig.l disconnected from lthe arm 12. A second type of flesh-engaging element39 'is shown mounted on arm 11 and having a substantially U-shaped blade41. 'Element 39 is used vvwhere there is only a -small amount of fattytissue surrounding the wound. The blade 41 is constructed of a vsturdyyrodlike material. The -ends 42 and 43 of .the blade '41 are seated in-sockets `43 formed in the sleeve lportion 32"; see Fig. 5, and arewelded thereto.

,1n an element having a web-like blade :as shown for arm 12 in Fig. l,thefdepending portion 44 of the blade 34 Ais inclined outwardly avslight amount vand the lower end 45 thereof is further bent outwardlythus providing more effective means for retaining the fatty'tissue. Thelower lend 45 is rounded and the side edges of -the blade are blunt thusVpreventing any possibility of tearing or injuring the tissue by theblade.

By providing elements of varying size 'and shape the usefulness oftheretractor is greatly improved.

The third spreader arm 13, comprises yan elongated handle 46'hav`ing alongitudinally extending slot 47 'formed therein. The outer end of thehandle is provided with aziinger-engaging loop 48 and laterallyextending Jwing portions 50,"which enable the surgeon to readily exert apulling force on the arm 13 for enlarging the wound. The handle 46 isadjustably mounted on a carrier 51, which vin turn iismounted forlongitudinal movement on the frame 10. A bolt 52 protrudes upwardly fromythe center portion 54 of the carrier 51 and extends :through the slot47 formed in the'handle. A Wing nut '53 threadably engages the bolt 52.The upper end ofthe 'bolt 52 is peened over, as seen in Figs. 2-4, thuspreventing disengagement of the wing nut -53 therefrom. Any danger,therefore, of the nut 53 becoming detached and finding its way into thepatients wound has been averted. Cutouts 55 are provided in slot y47through which the wing nut will pass when the ears 56 thereof arealigned longitudinally with the slot 47, and thus allow fordisassembling of the spreader arm 13 from `the -carrier for cleaningpurposes.

The carrier 51 comprises a pair of sleeves 57 and 58 which slidablyembrace rods a and 10b, respectively. A portion 60 approximately thewidth of handle v-46 is cut out of the upper peripheral vsurface of eachoi the sleeves 57 and 58, thus enabling the underside v62 of the handle46 to engage the peripheryof the'rods 10a and 10b. Shoulders 59 formedby cutout portion 60 off the sleeves serve as guides for Athe handle and'thus allow only movement of the 'arm 13 transverse o'f the rods 10a and10b. After `the 'arm has 'been 'withdrawn the desired amount, the wingnut 53 is drawn up tight on bolt 52 thereby causing'handle 46 to assumea 'relatively fixed or locked position with respect 'to "the -rods 10a:and '10b land vthe 'carrier 5-1.

A modified form of carrier 61 is shown in Fig. 4

vwherein 4the -upper Aperipherial surfaces of sleeves '57 and 58' aretrimmed so as to be disposed in a plane substantially tangential withrespect to the rods 10a and 10b. In this form of carrier no guideshoulders are provided and the arm 13 is free to pivot about stud bolt52 when the wing nut 53 is not drawn up tight.

To the inner end 63 of arm 13 is detachably secured a center retractorblade or flesh-engaging element 64. The blade 64 is constructed ofsturdy non-corrosive, metallic material. The blade k64 is arcuate inform and extends downwardly from the end 63. The side portions 65 of theblade are 'ared a slight amount as shown in Figs. 1, 7 and 8. The lowerend 66 of the blade 64 is rounded and blunt. Thus when the blade iswithdrawn there is no tearing of the patients flesh by the lower end 66,or the ared side portions 65 of the blade 64.

A :locking mechanism 67 is .provided for vblade 64 ihaving a .cover:piece 68 which is secured by welding ior any other suitable means toone surface :of the .blade. A slot 70 -is formed in the top of the coverpiece :68, see Fig. 7. The .cover `piece 68 is adapted to embrace theend 63 of the handle 46. The end 63 of the handle is provided with anopening 71, see Fig. S, which, -when the .blade is positioned thereon,is in registration with an opening 69 formed in the blade. A springhe'ld detent 72 .fis mounted on the upper surface 73 -of vthe handleadjacent .the end 63 thereof and .is adapted to be positioned within theslot 70 when -the kblade -and handle are assembled. Riveted at point '77to the underside `62 of the handle, adjacent .the end 63 `thereof is 1a,resilient tongue member '76. 'Formed on free end of ymember 76 Vis anub75, which is adaptableto normally project into opening 71 formed in thehandle `46. When the vblade and handle are assembled, the nub 75likewise projects through the opening 69 -formed 'in the blade 'andprevents disengagement of the fblade and handle until the detent 72 isdepressed. Upon :depression of detent 72, the nose portion 74 thereofprojects through openings 71 and 69 and abuts nub 75 thereby causing thelatter to be pushed out of Asaid openings. The tip of the nub isrounded, thus enabling the nub to `readily slip out of vopening 69 whenthe detent is depressedand .the blade is pulled endwiseoif the handle.

The outer vend78 of tongue member V76 is bent vdownwardly a yslightamount so as to facilitate the positioning of the blade onto end 63. Ashoulder 79 is formed on the underside 62 of the end 63 ywhich lservesas a stop lfor lthe blade, see Fig. 8. `When the kend #63 abuts thesholuder 79, the openings 69 and71 are in lregistration ,and-,the nub 75snaps in place y'into said openings.

--Various other types of `center blades, not shown, may be substitutedfor lthe one shown thereby increasing the usefulness .of the instrument.

Thus `it ,will be seen that a retractor `has been lprovided which is oflsimple design and is adapted to be easily handled and adjusted vto `itsdesired position b y the surgeon. Furthermore various parts of the1instrument may be substituted by ,other parts of zvarying size andshape vdepending on the 'conditions encountered during 'the operation.The number of small detachable devices, 'such as screws, has beenreduced ,to a minimum 'thereby averting the danger of these ,partslbecoming loose or iinding their way into the Apatients wound during'the operation.

While several embodiments'of the invention are shown above, it will beunderstood, of course, that .the invention is not to be limited thereto,-since Amany 'more modications -may be made and it is contemplatedAtherefore by the appended claims lto cover any such pmodiiications asfall within the true spirit and scope of 'this invention.

I claim:

l. A surgical retractor comprising a pair o'f parallel elongated rods,one of said rods lhaving a portion yof its periphery provided withratchet teeth, Aa laterally eX- tending elongated arm rigidly mounted onsaid rods, a second -laterally extending elongated arm slidably ymountedon both of said rods 'for movement longitudinally thereof toward or awayfrom said rigid arm, a springactuated pawl pivotally mounted on saidsecond larm and engageable with said ratchet teeth lfor 'locking vsaidsecond farm in various positions of longitudinal 'adjustment-on saidrods against movement toward said rigid arm, and a third laterallyextending elongated arm mounted on said rods intermediate said otherarms for movement laterally and longitudinally of said rods.

2. A surgical retractor comprising a pair of elongated spaced parallelrods, one of said rods having ratchet teeth formed on one side thereof,an elongated spreader arm rigidly mounted on both of said rods andextending laterally from the opposite side of said tooth rod, a secondelongated spreader arm extending laterally in substantially the samedirection as said rigid arm and being slidably and' detachably mountedon both of said rods and movable toward or away from said rst spreaderarm, a pawl pivotally mounted on said second spreader arm and adapted tonormally mesh with said ratchet teeth and lock said second arm againstmovement thereof toward said rigid arm, a carriage slidably mounted onboth of said rods intermediate said rst and second spreader arm, a thirdelongated spreader arm adjustably mounted on said carriage and havingone end of said third arm disposed intermediate said other arms, andreleasable means mounted on said carriage and engaging said third armfor holding said carriage and third arm in a ixed position relative tosaid rods and said rigid arm.

3. A surgical retractor comprising a pair of elongated substantiallylinear members disposed in spaced substantially parallel relation, afirst elongated arm mounted on both of said members and extendingangularly therefrom, a second elongated angularly extending arm mountedon both of said members for movement toward and away from said rst arm,sleeves slidably mounted on said second arm and engaging both of saidmembers for maintaining said second arm in a fixed angular position withrespect to both of said members, and spring actuated means disposedintermediate said members and mounted on said second arm and engageablewith one of said members for automatically locking said second armagainst movement toward said first arm.

4. A surgical retractor as dened in claim 1 in which said arms havetheir distal ends connected to flesh-engaging elements each including asleeve portion for embracing a distal arm end when said element is inassembled relation therewith, a blade extending laterally from saidsleeve portion, and a spring-biased detent mounted on and affixed tosaid sleeve portion for independent movement with respect thereto intoautomatic snap-in engagement with an indentation formed adjacent saiddistal arm end upon relative endwise movement of said sleeve portioninto assembled relation with respect to said distal arm end therebyeffecting locking of the latter and said element in said assembledrelation.

5. A surgical retractor as dened in claim 2 in which the flesh-engagingelements are removably mounted on the distal ends of the spreader arms;said elements each including an apertured elongated sleeve portion forsnugly embracing a distal arm end when said element is in assembledrelation therewith, a blade extending laterally from said sleeveportion, and a leaf-spring overlying said sleeve portion and beingsecured thereto at one end, the free end of said spring being providedwith a protuberance projecting through an aperture formed in said sleeveportion and automatically assuming a snapin engagement with anindentation formed in the distal arm end upon relative endwise movementof said sleeve portion into assembled relation with respect to saiddistal arm end and effecting locking of the latter and said element insaid assembled relation.

References Cited in the tile of this patent UNITED STATES PATENTS

